Management of varicella-zoster infection in 39 HIV-infected patients

OBJECTIVES: The main goal of this study was to assess therapeutic strategies in HIV-infected patients with varicella-zoster virus infection. PATIENTS AND METHODS: This retrospective study conducted between 1989 and 1996 concerned 39 HIV-infected patients who bad reached the AIDS stage and had at least one episode of varicella-zoster infection. Epidemiological, clinical and therapeutic data were recorded. Chi-squared test was used for comparisons. RESULTS: A total of 78 episodes of varicelia-zoster infection occurred including 39 primary episodes and 39 recurrences. Aciclovir (ACV) 200 mg per os was given in 27 cases as first intention therapy (mean dose 4000 mg/day for a mean 10 days), ACV 800 mg per os in 10 cases (mean dose 4000 mg per day for a mean 10 days), and intravenous ACV in 23 cases (mean dose 30 mg/kg/day for a mean 7 days). Foscarnet was used 5 times, 90 - 100 mg per day for 8 to 21 days. We did not observe any difference in efficacy between the three ACV formulations, probably because of the small number of patients in the series and the retrospective nature of the study. All of the failures of the oral treatments occurred in patients with CD4 counts below 100/mm(3). CONCLUSION: Aciclovir (800 mg) can be given in HIV-infected patients who develop non-complicated varicella-zoster virus infection, Intravenous acidovir should be reserved for severe disseminated and/or neurological forms and for highly immunodepressed patients (for example those with a CD4 count below 200/mm(3)). These findings should be confirmed by prospective studies. (C) 1999, Masson, Paris.